Workplace violence against healthcare workers is rampant, but solutions remain unclear, largely as a result of underrecognition and underreporting of the problem and poor-quality research, according to a review article published in the April 28 issue of the New England Journal of Medicine. The article stems from the tragic death of a surgeon at Brigham and Women's Hospital in Boston, Massachusetts, in January 2015. The surgeon was shot and killed by the son of one of his patients, who had died. The homicide gained widespread attention, but follow-up reports failed to represent the full extent of workplace violence in healthcare, according to review author James Phillips, MD, from Harvard Medical School and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

Far more common than homicide are the daily encounters with lower-level violence, such as verbal abuse, physical assault, intimidation, stalking, and sexual harassment, experienced by healthcare workers but often overlooked almost 75% of all workplace assaults between 2011 and 2013 happened in healthcare settings;

80% of emergency medical workers will experience violence during their careers;

78% of emergency department physicians nationwide report being the target of workplace violence in the past year;

the rate of workplace violence among psychiatric aides is 69 times higher than the national rate of workplace violence;

61% of home healthcare workers report violence annually; and

family physicians are also at high risk, although limited data exist in the outpatient setting.

In fact, underreporting represents a major hurdle to tackling the problem. Just 30% of nurses report workplace violence, whereas 26% of physicians do, according to one study. The professional culture of healthcare, which often considers violence as "part of the job," likely contributes. Underreporting is an "iceberg problem," according to Dr Gillespie. "You can see the tip of the iceberg, but you can't see everything underneath," he said, "There's so much underreporting that the problem is a lot worse than what the statistics show."

Uncertainty about what actually counts as violence may also play a role, especially in patients without full control of their faculties. Whether the act is intentional or not, it should always be counted as violence, according to Dr Gillespie.

"No violence should be tolerated, ever," he said, "If we made the assumption that all patients or visitors have the potential to become violent, we would interact with them differently, and we would be safer." Discounting unintentional violence can contribute to underreporting, he explained. Acknowledging and reporting even unintentional violence can help staff identify which patients have been violent in the past and take precautions, such as flagging a patients' chart, to avoid violence when the patient returns.

"The difference between intentional and unintentional are the consequences," Dr Gillespie added, "For the confused older adult, person with low blood sugar, or a child, there's no intent. It won't have a consequence, but you can still do a prevention plan."

No "One-Size-Fits-All" Solution Exists

"It would be difficult to expect our administrators to provide the limited funds toward something that may not work," Dr Phillips stressed, "If we're able to encourage researchers to find programs that work, we'll have a better chance of getting our administrators to buy-in and provide budgets that allow us to put those changes into place."

The authors and Dr Gillespie have disclosed no relevant financial relationships.

4 Comments to Workplace Violence Rampant in Healthcare:

This is really sad. As a nurse working of over 30 years I have to say that the violence shown towards us in the EDs is worse that I have ever seen. This si not just a picture of the USA this happens in Australia too. Health union says hospital violence out of control at Tweed Heads http://www.abc.net.au/news/2016-02-02/hospital-violence-out-of-control-tweed-heads-says-union/7131978.

And the effects can be felt with the rest of the team. When there is violence in that part of the hospital it starts to effect staff mood, moral and then output. Patients can have their treatment effected because of the actions of patients and the family of the patients. Terrible.

Many thanks for the comments and link, Rhonda and my apologies for not getting back to you sooner. I agree with your comments about the effects felt on a larger scale in healthcare - we need to ensure that all staff (not just the ED) are safe to do their jobs. R

Violence is also felt in the workforce in healthcare. A landmark investigation into female medical staff in Australia has found nearly half have experienced domestic violence, including one in 10 who had been abused by their partner in the past year alone. You can read more here https://www.abc.net.au/news/2018-07-03/nearly-half-of-female-medical-staff-experience-domestic-abuse/9931542